Kidney disease appears common in residents of Quezalguaque, Nicaragua, particularly in younger men, with features most consistent with tubulointerstitial disease. Further research is needed to elucidate the causes of kidney disease in this region.

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Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach.

IMPORTANCE Understanding geographic and financial barriers to health care is an important step toward creating more accessible health care systems. Yet, the barriers to dermatological care access for American Indian populations in rural areas have not been studied extensively. OBJECTIVE To evaluate the driving distances and insurance coverage for dermatological care and the current availability of teledermatological programs within the Indian Health Service (IHS) or tribal hospitals system. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods study was conducted from May 7, 2018, to September 1, 2018, and did not take place in any IHS or tribal health care facility in the continental United States. The study design involved a geographic analysis and a cross-sectional telephone survey with brick-and-mortar dermatology clinics (n = 27) and teledermatological programs (n = 49). Brick-and-mortar clinics were selected for their proximity to a rural IHS or tribal hospital. MAIN OUTCOMES AND MEASURES Mean driving distance from rural IHS or tribal hospital to nearest dermatology clinic, number of dermatology clinics within a 35-mile or 90-mile radius of IHS or tribal hospitals, insurance and referral types accepted by dermatology clinics, and number of teledermatological programs collaborating with IHS or tribal hospitals or health centers. RESULTS In total, 27 brick-and-mortar dermatology clinics and 49 teledermatological programs were identified and contacted for the survey. The median (interquartile range [IQR]) driving distance between rural IHS or tribal hospitals and the nearest dermatology clinic was 68 (30-104) miles. Of the 27 dermatology clinics in closest proximity to rural IHS or tribal hospitals (median [IQR] driving distance, 82.4 [31-114] miles), 25 (93%) responded to the survey, 6 (22%) did not accept patients with Medicaid, and 6 (22%) did not accept IHS referrals for patients without insurance. Of the 49 teledermatological programs, 45 (92%) responded and 14 (29%) were no longer active. Ten (20%) teledermatology programs were currently partnering (n = 6), previously partnered (n = 2), or were setting up services (n = 2) with an IHS or tribal site. Only 9% (n = 27) of the 303 rural IHS or facility in the continental United States reported receiving teledermatological services. CONCLUSIONS AND RELEVANCE Substantial geographic and insurance coverage barriers to dermatological care exist for American Indian individuals in rural communities; teledermatological innovations could represent an important step toward minimizing the disparities in dermatological care access and outcomes.

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People who are incarcerated or have a history of incarceration have high rates of dental disease, but access to dental treatment is often a challenge during and after incarceration. Dental students' exposure to this population is unknown: no data exist regarding the number of schools that provide didactic and clinical training in correctional dentistry. The aim of this study was to assess the extent of instruction in correctional dentistry and clinical opportunities at correctional facilities for dental students in the U.S. A survey was distributed to the academic deans at all 66 U.S. dental schools in 2017. Respondents were asked if their institutions had curricular content on correctional health and if they provided clinical opportunities in the correctional setting. Respondents from 30 schools completed the survey, for a response rate of 45%. Nearly two-thirds of the respondents said their institutions offered didactic instruction on the impact of incarceration on health, and eight schools offered a clinical experience at a correctional facility. The most common format was a community-based dental externship involving fourth-year dental students. Oral exams, prophylaxis, and extractions were the most common procedures performed. Respondents from schools that offered a clinical experience agreed more strongly than those that did not that exposure to correctional health care was important and that their students believed incarceration to be a social determinant of health. This study found that a substantial proportion of dental schools offered didactic education on correctional health, but a much smaller number offered student rotations in correctional facilities.

Jail-based student-run clinics, though uncommon, have the potential to impact the future health workforce. We evaluated, via a survey of student attitudes and a collection of lessons learned, a student–faculty collaborative clinic that was implemented in a jail in 2015. Clinic participation led to significantly greater student volunteer ratings of the importance of collaborating with oral health providers and of comfort in providing care to incarcerated populations. We report lessons learned regarding logistical considerations, volunteer behavior, and common issues arising in clinic visits. The clinic proved feasible and sustainable over several years, offering a new model for the involvement of trainees in correctional health care.

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